Insights on Poverty-based Inequality in Old-age Mortality in India

As the global population ages, understanding the effect of poverty on old-age mortality becomes increasingly important, especially in India, which is undergoing significant demographic and socio-economic changes. Although previous research has established a link between poverty and mortality, there is a critical need for panel studies to investigate this relationship specifically among older adults. This study addresses this gap by using panel data to examine the association between initial poverty status and subsequent mortality among older adults in India. Additionally, it explores the factors contributing to mortality disparities between poor and non-poor older adults. We analyzed panel data from two rounds of the India Human Development Survey. The age-sex standardized old-age mortality rates for poor and non-poor older adults were calculated using direct standardization. Mortality disparities were evaluated through bivariate and proportion tests, as well as multivariable logistic regression analyses. The Fairlie decomposition technique was employed to identify factors contributing to these disparities, with sensitivity analyses performed to ensure the robustness of the findings. The age-sex standardized old-age mortality rate for the poor was 31.9 per 100 people, with a 1.15 times higher likelihood of mortality [95% CI: (1.04,1.27)] between round-I to round-II compared to non-poor counterparts. Factors such as household wealth (33.6%), social class (17.1%), education (12%), and occupation (4.3%) were significant indicators of the poverty gap in old-age mortality. Surprisingly, chronic diseases, age, and gender negatively affect mortality disparity, while higher mortality in extended families suggests a weakening traditional support system. The findings underscore the importance of addressing ageist attitudes and enhancing social safety nets and affordable healthcare for older adults, who face higher risks of poverty and premature death. The elevated mortality among those in prolonged poverty cycles highlights the need for policymakers to reconsider universal support policies for older individuals. Specifically, if non-poor older adults have longer lifespans, policies centred solely on poor may not effectively address the needs of all older individuals.